Geriatric Considerations IN Nursing: Seminar ON
Geriatric Considerations IN Nursing: Seminar ON
Geriatric Considerations IN Nursing: Seminar ON
ON
GERIATRIC CONSIDERATIONS
IN
NURSING
VMCON. VMCON.
SUBJECT: ADVANCED NURSING PRACTICE
UNIT :IX NURSING PRACTICE
TOPIC :GERIATRIC CONSIDERATIONS IN NURSING
SNO CONTENT PAGE NO.
1. INTRODUCTION 1
-Demography
-Indian Scenario
2. DEFINITION 2
-It is a sub speciality of internal medicine that focuses on
health care of elderly people
-Meaning
-Retirement
-Elder abuse
-Suicide
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12. CONCLUSION
13. BIBILOGRAPHY 22
NAME OF THE STUDENT : MS SREELATHA.A
SUBJECT : ADVANCED NURSING PRACTICE
TOPIC : GERIATRIC CONSIDERATIONS IN NURSING.
UNIT :IX NURSING PRACTICE
CLASS :MSC (N) 1ST YEAR
TIME :
DATE :
DURATION :
OBJECTIVES
GENERAL OBJECTIVES:
By the end of the seminar students will be able to gain knowledge regarding the
geriatric considerations in nursing.
SPECIFIC OBJECTIVES:
At the end of the seminar students will be able
- to define Geriatrics.
DEMOGRAPHY:
The number of elderly increased more than 3 fold since 1950, from
approximately 130 million (4% of global population) to 419 million
(6.9%) in 2000.
The number of elderly is now increasing by 8 million per year; by
2030, this increase will reach 24 million per year.
INDIAN SCENARIO:
DEFINITION:
Geriatrics is a sub-speciality of internal medicine that focuses on health care of elderly
people.
It aims to promote health by preventing and treating disease and disabilities in older
adults.
MEANING :
The term Geriatric com the Geek word “geron’’ meaning “old man“ and “iatros’’
meaning “healer”.
However, geriatrics is sometimes called medical gerontology.
THEORIES OF AGING :
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3. Disengagement Theory.
4. Activity Theory.
5. Continuity Theory.
In 1950‘s Hay flick suggested that the human cell is limited in number of times it can
divide ,He theorized that it can divide 50 times ,after which they simply stop dividing (and
hence die).He showed that nutrition has an effect on cells, with overfed cells dividing
much faster than underfed cells, as cells divide to help repair and regenerate themselves.
The Hay flick limit indicates that there is a need to slow down the rate of cell division if
we want to live long lives .Cell division can be slowed down by diet and lifestyles etc.
Immunologic Theory:
According to this theory , the rate of aging is controlled by the immune system.
This Theory states that, as we age the number of cells start to decrease becoming less
functional.
2) Error Theories:
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Early Theory on aging proposed that there is a fixed storage of energy available to the
body. As time passes, the energy is depleted and because it cannot be restored, the person
dies.
Later, other theories emerged. The wear and tear theory stated that the body is like a
machine that wears out its parts with repeated use .The effects of aging are caused by
progressive damage to cells and body systems over time . This was not widely accepted.
It also reffered to as the glycolsylation theory of aging , was proposed by Johan Bjorksten
in 1942.
According to this theory an accumulation of cross linked proteins damages cells and
tissues, slowing down bodily processes resulting in aging .
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It states that an important part of aging is determined by what happens to our genes after
we inherit them. From the time of conception, our body’s cells are continually
reproducing.
Additionally, exposures to toxins , radiation or UV light can cause mutations in the body’s
genes.
The body can correct or destroy most of the mutations, but not all of them. Eventually, the
mutated cells accumulate, copy themselves and cause problems in the body’s functioning
related to aging.
Personality theory:
These theories address aspects of psychological growth without delineating specific tasks
or expectations of older adults.
Some evidence suggests that personality characteristics in old age are highly correlated
with early life characteristics.
Disengagement theory:
It describes the process of withdrawal by older adults from societal roles and
responsibilities.
According to this theory, this withdrawal process is predictable, systematic, inevitable and
necessary for proper functioning of a growing society.
The benefit to society is thought to be an orderly transfer of power from old to young.
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Activity theory:
This theory occurs when individuals engage in a full day of activities and maintain a level
of productivity to age successfully.
It says, the more you do, the better you will age.
People who remain active and engaged tend to be happier, healthier, and more in touch
with what is going an around them.
Continuity theory:
Also called developmental theory.
This theory is the follow up to the disengagement and activity the
It emphasizes the individual previously established coping abilities and personal character
traits as a basis for predicting how the person will adjust to changes of aging
Cardiovascular changes:
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Lungs become stiffer, muscle strength diminishes, and chest wall become more rigid.
Total lung capacity remains constant but vital capacity decreases and residual volume
increases.
Alveolar surface area decreases by upto 20% alveoli tend to collapse sooner on expiration.
There is an increase in mucus production and a decrease in the activity and number of
cilia.
Body becomes less efficient in monitoring and controlling breathing.
Kidney mass decreases by 25-30% and the number of glomeruli decrease by 30-40%.
These changes reduce the ability to filter and concentrate urine and clear drugs,
With aging there is a reduced hormonal response (vasopressin) and an impaired ability to
conserve salt which may increase risk for dehydration.
Stomach:
Liver:
-Reduced blood flow
-Altered clearance of some drugs
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-Diminishing the capacity to regenerate damaged liver cell.
Intestine:
-Prevalence of diverticulitis increase with age.
-Reduced perstalisis (intestinal muscle contraction) of large intestine.
-Skin:
Wrinkling ,pigment alteration and thining of skin. Elastin and collagen decrease.
Reduction in size of cells.
Loss of subcutaneous layer of fatty deposits.
Inability of skin to retain moisture.
-Hair:
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By age 50 years, the hair of more than hair of all is 50% gray .It is due to decrease in the
production of melanin (can be hormonal and hereditary).
-Vision:
Most common, about 95% of people aged 65 years or more report wearing glasses or need
glasses to improve their vision.
Lens of eye become yellowed, cloudy.
- Hearing:
Membrane in middle ear including the eardrum becomes less flexible with age.
Vestibular begins to degenerate with age leading hearing loss.
- Smell:
-Taste:
- Touch:
-Pancreas:
Muscle cells become less sensitive to the effects of insulin produced in the body.
The normal fasting glucose level rises 6-14 mg /dl every 10 years.
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Type 2 Diabetes mellitus occurs when the body develops resistance to insulin.
-Adrenal glands:
Aldosterone levels are 30% lower in adults aged 70 to 80 years than in younger adults.
Lower aldosterone levels may cause orthostatic hypotension.
Secretion of cortisol diminishes by 25% with age.
Memory functioning:
Intellectual functioning:
These abilities of older people do not decline but do become obsolete (out of date).
The age of their formal educational experiences is reflected in their intelligence scoring.
Learning abilities:
Loss of grief
Attachments to others
Maintenance of self identity
Dealing with death.
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Delirium
Dementia
Depression
Schizophrenia
Anxiety disorders
Personality disorders and sleep disorders.
Old age brings many important socially induced changes, some of which have the
potential for negative effect on both the physical and mental wellbeing of older persons.
Sexuality and the sexual needs of elderly people are frequently miss understood ,repressed
and ignored.
Retirement:
Sadock and sadock (2007) reported that, of those people who voluntarily retire, must
recentre the work force with 2 years.
The reasons they give for doing this include negative reactions to being retired, feelings of
being unproductive, economic hardship, and loneliness.
Retirement has both social and economic implications for elderly individuals.
Elder abuse:
Abuse of elderly individuals may be psychological, physical or financial and the neglect
may be intentional or unintentional.
Psychological abuse includes yelling ,insulting, harsh commands, threats ,silence and
social isolation,
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Physical abuse is described as striking. Shoving, beating or restraints.
Financial abuse refers to misuse or theft of finances , property to fulfill the needs of an
individual who can not do so independently.
In addition,elderly individuals may be the victims of sexual abuse.
Suicide:
People older than 65 years (12% of population) represent disproportionately high
percentage of individuals who commit suicide.
Of all the suicides 16% are committed by this age group.The group especially at risk
appears to be white men. Predisposing factors may include lonliness, financial problems,
physical illness, loss, depression, widowed, divorced.
Components of intervention with suicidal elderly person should include demonstration of
genuine concern, interest, caring solving their issues, prevent isolation.
Alzheimer’s disease:
It is slow and gradual disease that begins in part of brain that controls memory.
It affects a greater number of intellectual and emotional and behavioral abilities, it has no
known cause for this disease.
As person grows older, he is at greater risk of developing Alzheimers.
Strokes:
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About 1.5 million people have stroke, each year it is a 2nd leading cause of death for older
than 60 years of age.
Heart disease:
Hypertension (silent killer).
Osteoarthritis:
It is most common form of arthritis.
Rheumatoid arthritis:
Inflammation of joint lining in the synovial (free moving) joints.
Diabetes:
Due to lack of movement of work in old aged people.
Urinary incontinence:
About 1/3rd of women and 10% of all men above age of 60 have incontinence.
In this people loose control over their bladder and bowel movements.
Social isolation:
Isolation may be a choice, the result of desire not to interact with others.
May also be a response to conditions that inhibit the ability or the opportunity to interact
with others.
Causes of isolation :
-Health problems
-Feeling of rejection
-feeling of unattractiveness
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IMPORTANT CONSIDERATIONS IN THE CARE OF GERIATRIC CLIENTS
Physiological concern
Promotion of healthy life style
-This includes exercise, sleep and stress management. All these are needed to be promoted in
life of elderly people. It will prevent the occurrence of certain medical illness common in this
age.
-Regular exercise
-Management of HTN
-Smoking cessation
Diet In Elderly
The quality, not the quantity matters. The energy requirements of a person decrease with
increase in age. This to be of lowered basal metobolic rate and lessened physical activity.
There is an 8 % reduction per decade from 55-75 years.
Composition of diet:
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Proteins: In the elderly, up to 12-14% of the total calories should be from proteins, But,
due to decreased appetite and poor digestion, the elderly tend to consume less protein.
Fat: A diet with high content of saturated fatty acids (ghee, butter, coconut oil, unrefined
salt) tends to increase the level cholesterol in the blood.
Carbohydrates: The body needs carbohydrate because it cannot make it for itself from
other nutrients. So,it should not less than 100 grams per day.
Certain important minerals need to be included in diet which are as follows:
Calcium: It is very essential for an average elderly person. As people become older, the
bones become demineralised. So calcium intake should be not less than 400 mg per day.
Iron: Iron deficiency leads to anemia. So the diet of the elderly should contain sufficient
amount of iron. The recommended daily allowance is 30 mg per day.
Water: The fluid intake should be at least 1.5-2 liters per day in a normal elderly person.
Roughage or dietary fiber: The elderlies require sufficient fiber or roughage in their diet to
avoid constipation. Rough fibre is not well-tolerated by the intestine in old people. But,
the tender fiber of vegetables, fruits and whole-grain cereals will encourage normal bowel
movements.
Foods to avoid:
-High fat foods ,Saturated fats, meat products, full fat dairy products .
-High sodium foods: Canned, processed foods, salted nuts, sauce and salted snacks like
nuts.
Refined sugar: Cakes, cookies or candy.
Pressure injuries:
The older people have an aged skin and the skin appears thin and fragile. The age related
changes may lead to ulceration, All clinicians working with older people at risk for, or
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suffering from pressure ulcers must be mindful of these varying relationships in
consideration to plan and implement individualized , comprehensive care.
Medication In Geriatric Clients :
The elderly are at increased risk of adverse effects with certain drugs. Increased risk may
result from age-related changes in pharmacokinetics or pharmacodynamics .Risk of an
adverse effect increases exoponentially with the number of drugs used,partly because
multiple drug therapy reflects the presence of many diseases and increases risk of drug
disease drug –drug interaction.
Nurses role
Ensure safe and appropriate use of all medications.
Older adults should be taught the names of all drugs being taken
When and how to take them, desirable and undesirable effects of drugs
Examine for potential interaction with food or other drugs
-COMMUNICATION
One important aspect of elderly nursing is communicating effectively with the patient or
with family members.
-therapeutic touch :
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-Communication technique for visual impairment
-Reality orientation
It is a communication technique used to make an older adult move aware of time place
and person.
-Purposes
-Nurses role
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Changes in social roles, family responsibilities and health status influence older adults
living arrangements. Some choose to live with family members, other prefer their homes
apartments near their families.
-Management
-Nurse’s Role
-Objectives
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-Activities
It works to insure high standards of research and practice in gerontology, and to maximize
availability of gerontological services.
Conducts research in biological, clinical and psychosocial aspects of gerontology.
It was formed in 2001,a national organization to bring together and represent citizen
across India.
Today it has federations / associations covers following 14 states
Maharatra, Karnataka ,Andhra pradesh, Gujarat, Uttar pradesh ,Madhya Pradesh, jammu and
Kashmir , Assam, Haryana,Goa, Kerala and Rajasthan.
-Objectives :
To enable and support voluntary organizations and NGO’s to supplement the care
provided by family.
To provide care and protection to vulnerable groups.
To provide health care facility to elderly and to promote research and training facilities to
care givers.
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To create awareness among elderly persons to develop themselves into fully independent
citizen.
Revision of national policy on older persons:
CONCLUSION :
To overcome the geriatric problem and to ensure a good, healthy and quality of life, the
elderly members of society can move along way with support of the family members.
Although aging is a natural process, caring for an older person is not the same as caring for a
middle aged adult person.The peri-operative and peri-anesthesia nurses need to be competent
in geriatric nursing care and possess specialized knowledge and skills related a myriad of
geriatric issues. This seminar focuses on the special needs of elderly population and how the
peri operative nursing team may address their care best.
SUMMARY:
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Resources for care of older adults.
Steps taken by government.
BIBILOGRAPHY:
Brar KN, Rawat CH, A Textbook of Advanced Nursing Practice, 1st Edition, 2015,
Published by Jaypee Brothers Medical Publishers (P)Ltd , Page -1058-1071.
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Gentle touch conveys affection and friendliness It helps comfort the older
adult
Induce relaxation)
Sit or stand in front of the client in full view Face the older adult while speaking, do
not cover your face
Provide diffuse bright, non-glare lighting .Encourage the older adult to use his or
her familiar assistive devices such as glasses
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Speck directly to the cliem, do not cover your mouth
Feminders of person time and place the of environmental ads such as docks
calendars, perumal
Therapeutic communication
Changes in social roles, family responsblmes and health status order dig m with
family members, other prefer their homes apartments at the
Furniture should provide back support Bed should be comfortable and getting bit of
bed should be easier and sale
Nurse Role
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A safety, find risks in the enement and der adult ability is recognize and respond to
the risks Risk includes factors leading to injury, within heune, such as water heaters
set at exily hot temperament
Objectives
To organize scientific meetings, eher under its own auspices or jantly with other
organizations, and To publish journals reviews, abstracts, newsletter, etc. in
genunology
Encourage to use austive devices. Check the ear canal for cerumen impaction
Reality Orientation
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It is a communication technique used to make an older adult more aware of time,
place and personuring e il reality Printing socialization
Fmque reminders of person, nme and place Use of immental sids such as clicks,
calendars, personal belongings Theple communication
Answer questions simply and bonenty with sensitivity and a caring atmale
Changes in social roles, family responses and health status influence older aduls
Hiring arrangements Some che with family members, other prefer their even liomes
or apartments near their families
Fumiture should pride hack support Bed should be comfortable and getting out of
bed should be easier and safer
Norve's Role
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Association of Gerontology, Banaras
To organize scientific meetings, either under its own auspices or jointly with other
organizations, and To publish journals reviews, abstracts, newsletter, etc. on
gerontology
Wat iure high standards of research and practice in gerontology, and to maximise
availability of cali Conducta neatch in biological dinical and psychosocial aspects
of gerontologyAll India Senior Citizens Confederation
It was formed in 2001, a national organization to bring together and represent senior
citizens across India federatiomlasciations covers following 14 states Maharashtra,
Karnataka. Andhra Pradesh, Gujarat, Chhattisgarh, Uttar Pradesh, Madhya Pradesh,
Bihar, Jam&Ka
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STEPS TAKEN BY GOVERNMENT
National policy for older persons:
It was announced in 1999 by the ministry of Social justice and empowerment
Objectives are:
To enable and support voluntary organizations and NGO’s to supplement the care
provided by family.
To provide care and protection to vulnerable groups.
To provide health care facility to elderly and to promote research and training facilities to
care givers.
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To create awareness among elderly persons to develop themselves into fully independent
citizen.
Revision of national policy on older persons:
It was created in March 14, 2010.
Age of senior citizen is different for different benefits such as:
60 years for concession in railways.
60 years by bank for extra 0.5% interest to senior citizen
63 years for concession in air journey by Indian air lines.
65 years for benefit to senior citizens under income tax.
CONCLUSION :
To overcome the geriatric problem and to ensure a good, healthy and quality of life, the
elderly members of society can move along way with support of the family members.
Although aging is a natural process, caring for an older person is not the same as caring
for a middle aged adult person. The peri-operative and peri-anesthesia nurses need to
be competent in geriatric nursing care and possess specialized knowledge and skills
related a myriad of geriatric issues. This seminar focuses on the special needs of
elderly population and how the peri operative nursing team may address their care best.
SUMMARY:
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Introduction of Geriatric consideration In Nursing
Definition of Geriatrics.
Theories of Aging.
Changes associated with Aging.
Common problems in old age.
Important considerations in care of geriatric clients.
Resources for care of older adults.
Steps taken by government.
REFERENCES
Brar KN, Rawat CH, A Textbook of Advanced Nursing Practice, 1st Edition, 2015,
Published by Jaypee Brothers Medical Publishers (P)Ltd, Page -1058-1071.
Kaur L, Kaur M, A Textbook of Nursing Foundation ,2nd Edition, Published by S.Vikas
and company page -69.
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